Healthcare Contact Days Before and After Liver Transplant in Patients With Cirrhosis: A National Cohort Study

"Healthcare contact days" is a patient-centered quantitative proxy for time toxicity, which can be informative for liver transplant (LT) decision-making. We aimed to (i) quantify contact days in patients with cirrhosis pre-LT and post-LT and (ii) identify clinical and demographic features associated with contact days.

Using a national health system database, we calculated healthcare contact days (inpatient, outpatient hospital [e.g. observation], ambulatory, emergency, mental health, other) for patients with cirrhosis before and after LT.

Between 2008 and 2023, 2,708 patients underwent LT (median age 59 years [interquartile range 52-65], 66% male, 68% non-Hispanic White). Total mean contact days were 76.0 (SD, 58.6) 1 year pre-LT, increasing to 92.3 (SD, 63.2) 1 year post-LT, then decreasing to 39.7 (SD, 43.3) and 30.9 (SD, 35.6) 2 years and 3 years post-LT, respectively. The mean inpatient contact days were 33.6 (SD, 47.5) 1 year pre-LT, increasing to 49.6 (SD, 59.1) 1 year post-LT, then decreasing to 11.9 (SD, 32.0) and 6.7 (SD, 19.8) 2 years and 3 years post-LT, respectively. In multivariable analysis, pre-LT contact days were not associated with post-LT days (incidence rate ratio [IRR] 1.00 [1.00-1.00]). Post-LT, female gender (IRR 1.09 [1.03-1.15]), Black race (IRR 1.11 [1.00-1.23]), and pre-LT dialysis (IRR 1.21 [1.10-1.34]) were associated with increased total contact days.

Healthcare contact days provide interpretable prognostic information to inform expectations regarding LT for cirrhosis and can be useful for patients, providers, and policymakers alike.